The 2009 AIDS Epidemic Update by UNAIDS can be viewed by clicking here.

In a move to counter social exclusion and change discriminatory practices, a dialogue has begun in Pakistan between the government, parliamentarians and communities often overlooked by policymakers. An historic meeting was held late last month when a number of parliamentarians began a dialogue with community members on the challenges facing transgendered people, people who use drugs and people living with HIV. This meeting was a first, and aimed to create an enabling environment for policy changes related to HIV.

Peer outreach workers, Infection Control Society of Pakistan, Karachi. Credit: UNAIDS/P. Virot

Among the general population in Pakistan HIV prevalence is less than 0.1%, however results from the recent HIV Second Generation Surveillance in the country indicate that injecting drug users and the transgender community are the two populations with the highest rate of HIV infection in the country, with an estimated 20% and 7% prevalence respectively. HIV infection is not the sole concern of these populations who can also be caught up in a cycle of social and economic exclusion exposing them to marginalization and violence, limited access to health and others services, and, for drug users, a lack of drug substitution programmes.

The dialogue, held at a parliamentary sub-committee level, brought together parliamentarians from across party lines; associations and groups representing people living with HIV such as the Red Ribbon Initiative, Pak Plus and New Light AIDS Control Society; the Sathi Foundation for transgenders; as well as Nai Zindagi, an organization that provides services for drug users.

It was also an opportunity for parliamentarians to discuss with senior police, narcotics control and health officials who were present the need for changes in policy and practice towards key groups. Discussions ranged from an urgent call to push through pilot substitution therapy which is still awaiting final government clearance, to introducing a special focus on transgender within police training and investigations on sexual violence and abuse perpetuated against them.

“Leadership shown by a few, through a courageous dialogue with parliamentarians represent a voice of change for countless others.”

- Oussama Tawil, UNAIDS Country Coordinator for Pakistan

Outreach Work among drug users. Nai Zindagi, Lahore. Credit: UNAIDS/P. Virot

The government of Pakistan already endorses harm reduction within a wider approach to drug prevention and control, and non-governmental organizations collaborate closely with the Ministry of Health on needle exchange programmes.

Discussions also touched on issues affecting the general population. People living with HIV in Pakistan risk losing their employment or at times refusal by health workers to provide care to them; and people working overseas such as in the Gulf States have faced deportation back to Pakistan once detected HIV positive.

The Pakistan government’s response to HIV began in 1987 with the establishment of a Federal Committee on AIDS by the Ministry of Health, soon after the first case of AIDS was reported. Today the country’s National AIDS Control Programme is implemented through federal and provincial implementation units.

Funding gap

However Pakistan is currently facing a considerable gap in funding the scale-up of community-based efforts which represent the backbone of the national AIDS response. The country benefits from donor support, in particular from the World Bank, UK and other bi-laterals to scale up HIV prevention, treatment, care and support. Despite applications for resources from the Global Fund to Fight AIDS, TB and Malaria in recent years, grants on HIV have yet to be secured though needs are clear.

Needle disposal programme for people who inject drugs. Nai Zindagi, Lahore. Credit: UNAIDS/P. Virot

Speaking during the meeting, Member of the National Assembly and Chair of the Parliamentary Sub-Committee on AIDS, Dr Donya Aziz said, “Donor support is essential for us at this point, yet, in the long run, we cannot rely on external funds. Public and private sectors must mobilise resources, while policy decisions are needed to ensure services and to address social exclusion in our communities.”

In spite of the challenges ahead, participants at last month’s gathering felt that the breakthrough in challenging mistrust towards communities heralded by this meeting is an important milestone on which progress can be built.

The dialogue is just the beginning and will be followed up with a series of meetings to be held among a larger forum of parliamentarians across party lines and civil society groups. Hopes are high that policy change and attitude change will also follow.

UNAIDS Country Coordinator for Pakistan Oussama Tawil echoes this hope, “Leadership shown by a few, through a courageous dialogue with parliamentarians represent a voice of change for countless others.”

KARACHI, May 9: Experts speaking at a seminar on Saturday said that swine flu (A H1N1) virus, if at all entered the city, would have little chance to survive or surge owing to the hot and humid environment here. However, they warned, health providers were required to remain alert till the advent of winter.

Dr Iftikhar Ahmed and Dr Rafique Khanani, both associated with the Dow University of Health Sciences (DUHS), were expressing their views at the seminar on “Swine Influenza”, a virus that has been declared a pandemic by the World Health Organisation (WHO). The virus, after its outbreak in Mexico, has infected more than 2,500 people in about 25 countries and already caused dozens of deaths.

Organised by the DUHS, the seminar was presided over by its Pro-Vice-Chancellor, Prof Salahuddin Afsar.

Dr. Iftikhar Ahmed, the head of infectious diseases department at the DUHS, observed that swine flu was a highly contagious, acute respiratory disease of pigs, caused by one of several swine influenza-A viruses that regularly caused outbreaks of influenza in pigs and occasionally caused human-to-human transmission.

He said that though the exact time and location of the outbreak of the latest swine influenza was unknown, it was believed to have been first detected when influenza-like illness was reported by the health agencies and local news media in Mexico. The virus responsible was clinically defined as a new strain of influenza on April 24, 2009.

He said that pigs were now considered as a mixing vessel since they could catch human and avian or pig flu. “When flu viruses from different species infect pigs, they can mix inside the animal and create new mixed viruses,” he added.

“Our best countermeasure – vaccine – will probably be unavailable during the first wave of pandemic while antiviral treatment may improve outcomes, though will have only modest effect on transmission,” he remarked. He said that in the given situation, prevention was the best measure and individuals should cover their nose and mouth with a tissue when they cough or sneeze and trash the tissue after the use.

Dr Ahmed said that the symptoms of H1N1 virus were similar to those of seasonal flu and included fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people infected with this virus also reported diarrhoea and vomiting, he added, observing that the virus had the same properties in terms of spread as seasonal flu viruses.

Elaborating, he said that with seasonal flu, studies had shown that people might be contagious from the day before they developed symptoms till up to seven days after they fell sick. Children, might potentially be contagious for longer periods.

About preventive measures, he said that people should often wash their hands with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners were also effective. They should also avoid touching their eyes, nose or mouth as germs spread this way. The infected people should stay indoors for a week or so and other people should not come in direct physical contact with them.

Dr Rafique Khanani was also of the view that there was little chance for H1N1 to survive in the weather conditions that prevailed currently in the southern parts of the country. Hot and humid conditions were less favourable for the virus to spread but at the same time it was necessary to continue with the vigilance exercises and remain prepared as the virus could hit with more intensity the countries already affected by it. The virus, he said, was very much fragile outside the animal or human bodies but could have an intensified transmission in winters.

He warned that the comforts like air-conditioning of houses, offices and vehicles could help the virus to spread although the outdoor climate was not favourable for its spread. A degree of caution should be observed in this regard.

Dr Khanani, who is also the president of Infection Control Society, Pakistan, said that the swine virus contained gene segments from different influenza types —North American swine, North American avian, North American human and Eurasian swine — and it had acquired two new tools/capabilities: 1) Human-to-human transmissibility and 2) Enhanced virulence.

He said that WHO had raised the alert level to Phase 5. Its alert system was revised after avian influenza began to spread in 2004, and April 27 this year was the day when it was raised above Phase 3. On April 29, it was raised to Phase 5, which was characterised by human-to-human spread of the virus into at least two countries in one WHO region.

While most countries are not likely to be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalise the organisation, communication and implementation of the planned mitigation measures is short.

Highlighting the transmission of influenza A (H1N1) to human, Dr Khanani said that it happened through contact with infected pigs and humans or the environments contaminated with swine flu viruses.

“A confirmed case of swine influenza-A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory-confirmed swine influenza-A (H1N1) virus infection by real-time RT-PCR or viral culture,” he concluded.

Source: Dawn.com

Welcome to the web site of the Infection Control Society Pakistan (ICSP). ICSP is a body representing specialist practitioners in infection control. It is the first organization in Pakistan, which seek to work with government, professional Associations/Colleges and industry, to educate health practitioners as well as the public about infection control principles and procedures.

Our organization is committed to developing and setting standards for infection control throughout Pakistan. As a scientific organization we firmly believe in continuous research and development to address infection risks, particularly those associated with health care. Since the inception of ICSP, it has helped in setting infection management and prevention procedures in many health care institutions throughout Pakistan.

ICSP seeks to apply the philosophy of total quality management throughout the whole spectrum of our society. Our projects for promoting infection control principles throughout Pakistan’s health care system, symbolizes a continuous effort for the improvement of basic health and better understanding of infections in the society. It is our firm belief that infection control policies within health care settings and communities can provide cost relief to our already burdened health care system and poverty stricken public.